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The national debate over universal government-funded health care is nothing new. Several U.S. presidents preceded Barack Obama in the effort to reform the health care system. On several occasions, they, too, believed that they were on the verge of success only to be defeated by Congress and special interest groups.

This long-standing debate and its influence on the history of heath care in our region will be a major topic of the 19th Annual Northeastern Pennsylvania History Conference. The conference, co-sponsored by Luzerne County Community College and the Luzerne County Historical Society, will be held at LCCC's Educational Conference Center on Friday beginning at 9 a.m.

The keynote speaker is William C. Kashatus, M.D., a local oncologist, professor at Hahnemann Medical College and former Smith Kline Beecham administrator. Kashatus will present an historical overview of health care in northeastern Pennsylvania. Dr. Dana Clark, chairperson of LCCC's Nursing Department, will also speak on the changing landscape of nursing in the region.

The talks will be followed by a living history performance of Esther Tinsley, the famous administrator of the old Pittston Hospital. Local historian Lisa Lewis will do the impersonation and then introduce the film, "Haven on the Hill," which chronicles Tinsley's career at Pittston Hospital.

There will also be an afternoon panel discussion focusing on the future of health care, which will address several issues including the current debate on universal health coverage. Panelists are: Doris Bartuska, M.S., former dean and professor, Women's Medical College, Philadelphia; John F. McGeehan, M.D., Horizon Medical Group; and Robert Wright, M.D., director of the Scranton-Temple Residency Program.

The conference is open to the public at no charge.

The debate over universal health care in the United States can be traced to 1915 when the American Association of Labor Legislation (AALL) drafted a bill that would provide health insurance for the working class and others who earned less than $1,200 a year, including dependents.

The services of physicians, nurses and hospitals were to be covered by the insurance as well as sick pay, maternity benefits, a death benefit of $50 and funeral expenses. The cost of the insurance would be shared by workers, employers and the state.

In 1916, the AALL co-opted the support of the American Medical Association (AMA) and together they pushed for a system of compulsory health insurance based on the AALL model.

Opposition to the plan quickly mobilized.

Many state medical societies opposed the initiative because of disagreement on the method of paying physicians.

The American Federation of Labor rejected the bill, fearing that a government-based insurance system would weaken unions by usurping their role in providing social benefits, The AFL played on public fears by calling the measure an "unnecessary paternalistic reform" that would create "a system of state supervision over people's health."

Private insurance companies also rejected the AALL-AMA plan because it covered funeral expenses, a major part of the multimillion-dollar commercial life insurance industry.

Instead of joining the debate, presidents from Taft through Hoover, mostly conservative Republicans, sat on the sidelines. Their indifference combined with strong opposition from physicians, labor, insurance companies and business, was too strong for the reformers to overcome. Within a year's time, the AMA distanced itself from the concept of compulsory national health insurance.

During the 1920s, rising health care costs - especially hospital care -shifted the debate from stabilizing income to financing and expanding access to medical care. It seems that the Great Depression of the 1930s would have created the ideal conditions for passing compulsory health insurance in the United States. Acting on that belief, President Franklin D. Roosevelt, in 1935, attempted to include universal health insurance as part of the Social Security Bill.

But with millions out of work, unemployment insurance took priority. FDR removed the health insurance measure because he believed that the entire Social Security bill would be defeated by the AMA, which now opposed the concept.

FDR tried again to implement universal health care in 1939, and the AMA torpedoed that initiative as well.

When President Harry Truman made a similar proposal in 1945, the AMA co-opted the support of the pharmaceutical industry and the American Bar Association to defeat it. At a time when anti-Communist sentiment was growing in the United States, the AMA played upon the public's fear of "socialized medicine."

The AMA insisted that a comprehensive universal health care plan would "make doctors slaves," even though Truman emphasized that doctors would be able to choose their method of payment.

There were few national health insurance initiatives until 1958, when Rhode Island congressman Aime Forand introduced a new proposal to cover hospital costs for the aged based on social security. It proved to be a watershed in the debate.

The elderly were overwhelmingly poor, even with Social Security. They had few or no resources for medical care precisely at the age when they needed it most. Forand's proposal triggered a major grass roots crusade from senior citizens, forcing the issue onto the national agenda.

The AMA countered by introducing an "eldercare plan," which was voluntary insurance that would provide broader benefits and physician services. In response the Kennedy administration proposed legislation to cover physician services.

Again, the AMA charged "socialized medicine," while private insurers resisted the plan because it would deprive them of customers over the age of 65.

But the AMA and the private insurance industry was no match for Lyndon B. Johnson who, after winning a landslide victory in 1964, exploited his political capitol by pushing through legislation that created Medicare and Medicaid, government-subsidized health care coverage for the poor and the elderly.

Johnson's was the last major victory for national health care insurance, but it could not anticipate the demands that have been placed on Medicare and Medicaid over the last two decades.

Today, there are 46 million Americans - including 9 million children - who are uninsured. To address the need, President Obama has proposed a "public option" - the creation of a government-sponsored insurance plan to compete with private insurance providers -- as part of his $900 billion universal health care reform.

History teaches that the president will confront stiff opposition from private insurance providers as well as the AMA and members of congress who receive large campaign contributions from the medical industry.

But the past also offers hope that the kind of grass roots movement, which contributed in part to the passage of Medicare, can work again if the president is wise enough to capitalize on it.

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